Learning objectives
The primary purposes of this educational exhibit were:
to outline the factors that increase the incidence of vertebral fractures in patients with ankylosing spondylitis (AS);
to review the radiological features of these conditions.
Background
Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthopathy mainly affecting the axial skeleton [1].
The ankylosed spine is prone to fracture even after a minor trauma and patients with AS have a fourfold vertebral fracture risk during their lifetime compared to healthy individuals [2,
3].
A delay in diagnosis often occurs due to both patient and doctor related factors.
Even in the presence of symptomatic clinical vertebral fractures,
patients frequently fail to differentiate acute fracture-type pain from preexisting inflammatory pain,
so the diagnosis is often...
Findings and procedure details
Mechanism of injury,
location and types of fractures in AS patients
Interestingly,
fractures in AS patients have the following distinctive characteristics:
the majority of fractures occur after low-energy trauma [1,
2,
6,
12-14]:due to its changed biomechanical properties,
the forces needed to fracture an ankylosed spine are smaller than those required to fracture a normal spine.
Therefore,
in the AS spine even a trivial trauma (i.e.
falls from standing/sitting position) can result in a fracture of the vertebral body or its other components.
Sometimes,
fractures...
Conclusion
Spinal fractures are common in patients with AS and can occur even after minimal or no trauma.
Fractures of the ankylosed spine tend to be unstable,
because ossified ligaments also fracture.
As a result,
neurological complications represent a major risk.
Recognition of these fractures can be challenging on the basis of radiographic examination alone.
Patients with AS presenting with a trivial history of trauma or new pain symptoms should be critically evaluated for acute spinal fractures using CT and/or MR imaging,
even if radiograph appears...
Personal information
M.
Marino,
Institute of Radiology,
Catholic University,
School of Medicine,
Largo Agostino Gemelli 8,
00168,
Rome.
A.
Leone,
Institute of Radiology,
Catholic University,
School of Medicine,
Largo Agostino Gemelli 8,
00168,
Rome.
A.
Semprini,
Institute of Radiology,
Catholic University,
School of Medicine,
Largo Agostino Gemelli 8,
00168,
Rome.
L.
Tonetti,
Institute of Radiology,
Catholic University,
School of Medicine,
Largo Agostino Gemelli 8,
00168,
Rome.
V.
Zecchi,
Institute of Radiology,
Catholic University,
School of Medicine,
Largo Agostino Gemelli 8,
00168,
Rome.
C.
Colosimo,
Institute of Radiology,...
References
[1] Jacobs WB,
Fehlings MG. Ankylosing spondylitis and spinal cord injury: origin,
incidence,
management,
and avoidance.
Neurosurg Focus 2008; 24(1): E12.
[2] Westerveld LA,
Verlaan JJ,
Oner FC.
Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment,
neurological status and complications.
Eur Spine J 2009; 18(2): 145-156.
[3] Finkelstein JA,
Chapman JR,
Mirza S.
Occult vertebral fractures in ankylosing spondylitis.
Spinal Cord 1999; 37(6): 444–447.
[4] Sambrook PN,
Geusens P.
The epidemiology of osteoporosis and fractures in ankylosing...